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Contemporary Conflict Means Changes for Humanitarian Healthcare

Dr Paul Spiegel

Contemporary armed conflict increasingly involves warring parties without uniforms or centralised command structures. Instead of lining up armed units on a battlefield, small cells often pitch battle intermittently before melting back into the civilian population. Disguise, dispersed command structures and longevity are frequently the weapons of modern warfare.

Large armies are having to rethink their structures to cope with the increasing use of hideouts, disguised munitions and low-tech weaponry. Meanwhile, medical aid workers are also having to rethink the way they attend to patients affected by contemporary conflict.

Paul Spiegel, chief of UNHCR’s Public Health and HIV Section, co-authored a report on the issue which was published in The Lancet on 23rd January 2010. It said:

…old paradigms for developing countries with large, camp-based refugee populations with infectious diseases and malnutrition do not address the complexity of present and future conflicts…

…most contemporary wars are of protracted duration, intrastate, fought by irregular armed groups and fuelled by economic opportunities and ethnic rivalry. Direct armed clashes are often infrequent, but violence against civilians, including rape, is pervasive. This violence takes place against a backdrop of increasing urbanization and ageing populations…

…As the profile of conflict-affected populations changes over time, so does the burden of disease. Infectious diseases and neonatal disorders remain the largest cause of excess mortality in conflict settings of low incomes and life expectancies. However, burgeoning, overcrowding-related epidemics (eg, cholera, shigella, and measles) might be arising less frequently than previously because an increasing number of populations live in non-camp-like settings. Furthermore, scaled up malaria and measles control programmes seem to be having a substantial effect….

Increasing the capacity of indigenous healthcare programmes is a new way to tackle the health implications of modern warfare. Doubling up healthcare provision by flying in foreign health workers not only increases tensions between differently treated groups in the country in question, but is also financially problematic against a backdrop of increasingly protracted conflicts.

The full report is entitled: “Health-care needs of people affected by conflict: future trends and changing frameworks”. Dr Paul B Spiegel MD, Francesco Checchi MHS, Sandro Colombo MD, Eugene Paik BA The Lancet,  Volume 375, Issue 9711, Pages 341 – 345, 23 January 2010.

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